Treatment of urticaria. An evidence-based evaluation of antihistamines.

Urticaria is a cutaneous syndrome characterized by dermal edema (wheal) and erythema (flare) that blanches with pressure. The lesions typically last less than 24 hours and are usually pruritic. In 1983, Christensen and Maibach summarized the theory behind the use of histamine H1 receptor antagonists (antihistamines) in clinical dermatology. These agents remain the mainstay of treatment for urticaria. This article reviews the medical literature on the effectiveness of antihistamines in urticarial syndromes, including acute, chronic idiopathic and the physical urticarias. Older antihistamines, such as chlorpheniramine and hydroxyzine, are effective in the treatment of urticarias, but they also have marked sedative and anticholinergic effects. Newer nonsedating antihistamines (second-generation antihistamines) have been developed that have reduced adverse effects because they do not cross the blood-brain barrier; these agents (acrivastine, cetirizine, loratadine, mizolastine, fexofenadine, ebastine, azelastine and epinastine) cause significantly less sedation and psychomotor impairment than their older counterparts. A review of the literature reveals that there are few studies which document the efficacy of second-generation antihistamines in the treatment of acute urticaria, a biologic entity that usually resolves within 3 weeks. We did not identify controlled studies that suggested superiority of any antihistamine in the treatment of acute urticaria. Loratadine or cetirizine, and possibly mizolastine, appear to be treatments of choice for chronic idiopathic urticaria. For symptomatic dermatographism, the combination of an antihistamine and an H2 antagonist, e.g. chlorpheniramine and cimetidine, appears to be effective. Very few studies have been conducted on the use of antihistamines in the treatment of cold, cholinergic, and pressure urticaria. Antihistamines are the mainstay of urticarial therapy. This evidence-based review suggests that there are efficacy differences between newer, nonsedating antihistamines and older agents in some forms of the disorder. Clearly, further well-controlled clinical trials in larger numbers of patients are needed to clarify the role of these agents in the treatment of urticaria.

Mobile and portable dentistry: alternative treatment services for the elderly.

With the rapidly expanding geriatric population in the United States, the demand for geriatric dentistry is rising. With the financial, transportation, and motivational barriers the geriatric population faces, it can be difficult for them to seek dental treatment in a traditional setting. Mobile and portable dental units can be used as alternative methods to provide dental care to the geriatric population. Mobile and portable dental units offer advantages such as providing community outreach, increasing personal satisfaction for geriatric clients and dental professionals, and providing dental care to those who would otherwise not receive treatment due to some of the barriers. Although mobile and portable dental units are ideal for long-term facilities, disadvantages do exist in implementing the use of these systems. These include the initial cost of implementing such a unit, limitation of treatment options, the number of clients seen in a day, and maintenance for the unit. Until more research can be done to find ways to improve the quality of dental care for the geriatric population, these units seem to be a reasonable alternative to the traditional approach to providing the elderly with the dental care they require.

Is contact allergy in man lifelong? An overview of patch test follow-ups.

In contradistinction from certain strains of mice, contact allergy in man is hypothesized to be either lifelong or at least to last for years. We examined follow-up studies on contact allergy, as evaluated by patch testing, attempting to quantify its natural history. The allergens include colophonium, gold sodium thiosulfate, nickel, and cobalt. At present, due to technical limitations, we cannot state in quantitative terms whether contact allergy in man is lifelong and whether its clinical manifestations change. Thus, we list some criteria for future studies which may help resolve the above question.

Female adolescent drinking behavior: potential hazards.

A recent national survey on the use of alcoholic beverages revealed that 93% of boys and 87% of girls in their senior year of high school had experimented with alcohol, and more than half of the country's seventh graders had tried drinking at least once during the previous year (1973). A review of the literature confirms this apparent increase in drinking by boys and girls. This article reports the increasing use of alcohol by girls and the associated risks. Some predisposing personal and behavioral characteristics are discussed, such as: the particular hazards of fetal syndrome; the significant impact of the physiological and psychological effects of menstruation and other related female phenomena; and the confusion in sex roles (resulting from the inability to freely combine masculine and feminine personality characteristics within onself in a women's liberation environment) accelerating "risk" possibilities in girls.